Heo Eunjeong, Choi Yoonhee, Kim Hyung-Sook, Namgung Hyung Wook, Lee Eunsook, Lee Euni, Lee Ju-Yeun, Jung Jongtak, Kim Eu Suk, Kim Hong Bin, Song Kyoung-Ho
Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Pharmacy, Yeungnam University Medical Center, Daegu, Korea.
Infect Chemother. 2023 Jun;55(2):185-193. doi: 10.3947/ic.2022.0092. Epub 2022 Dec 16.
Systematic protocols for the management of outpatient parenteral antimicrobial therapy (OPAT) and information on the current status of a prescription of parenteral antibiotics for outpatients and referred patients are lacking in the Korea. This study aimed to describe the current status of OPAT at a tertiary care hospital in Korea.
This was a retrospective study of outpatients and referral patients who were prescribed parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, indications for antimicrobial therapy, institution administering the antimicrobial injections, and pre- and post-prescription management.
Of the 577 prescriptions assessed in this study, 399 (69.2%) and 178 (30.8%) were delivered using the referral and outpatient models, respectively. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem [26.0%], ceftriaxone [12.8%], kanamycin [11.8%], amikacin [10.1%], and cefazolin [8.5%]) accounted for 69.2% of the total OPATs. Urinary tract (27.3%), respiratory (20.8%), and intra-abdominal (15.9%) infections were the most frequent indications for OPAT. After prescription, there were 295 (73.9%) and 150 (84.3%) follow-up visits in the referral and outpatient models, respectively ( <0.05). Laboratory tests necessary for monitoring were fully performed for 274 (47.5%) prescriptions.
We found that a significant number of OPATs were prescribed, follow-up visits were not performed in the case of about a quarter of prescriptions, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering the limited resources and the distribution of OPAT prescriptions, an effective strategy may be to select the frequently-used antibiotics or frequently-prescribing departments and start the program with them.
韩国缺乏门诊胃肠外抗菌治疗（OPAT）的系统管理方案，也缺乏门诊患者及转诊患者胃肠外抗生素处方现状的相关信息。本研究旨在描述韩国一家三级医院的OPAT现状。
这是一项对2019年7月至12月开具胃肠外抗生素处方的门诊患者及转诊患者的回顾性研究。我们审查了所开具的抗菌药物、抗菌治疗的适应症、进行抗菌注射的机构以及处方前和处方后的管理情况。
在本研究评估的577份处方中，分别有399份（69.2%）和178份（30.8%）采用转诊模式和门诊模式开具。约70%的OPAT处方由肺病科、传染病科、骨科、胃肠病科和血液科开具。五种抗生素（厄他培南[26.0%]、头孢曲松[12.8%]、卡那霉素[11.8%]、阿米卡星[10.1%]和头孢唑林[8.5%]）占OPAT总数的69.2%。尿路感染（27.3%）、呼吸道感染（20.8%）和腹腔内感染（15.9%）是OPAT最常见的适应症。处方后，转诊模式和门诊模式分别有295次（73.9%）和150次（84.3%）随访（<0.05）。对274份（47.5%）处方进行了监测所需的实验室检查。
我们发现开具了大量的OPAT处方，约四分之一的处方未进行随访，超过一半的病例未充分进行实验室监测。因此，有必要建立适当的OPAT管理方案。考虑到资源有限和OPAT处方的分布情况，一个有效的策略可能是选择常用抗生素或经常开具处方的科室，并从这些科室开始实施该方案。
